Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Etiology/Pathophysiology:
ECMO is a technique for pulmonary bypass, used to support patients
with severe respiratory and or cardiac failure who are not responsive
to conventional therapy. The idea is to allow the lungs time to heal
with mechanical ventilation being reduced to minimum levels. Through
large bore canulas unoxygenated blood is removed from the body,
passed through the ECMO circuit which oxygenates the blood, and then
reintroduced into the body through a large bore canula. The most
common indications for ECMO are meconium aspiration, congenital
diaphragmatic hernia and neonatal pneumonia which are severe enough
to result in pulmonary hypertension and right to left shunting.
Pathology:
Not Applicable
Imaging Findings:
The Endotracheal tube (ETT), Nasogastric tube (NGT), Feeding tube
(FT), Central venous line, Umbilical arterial catheter (UAC), and
Umbilical venous catheter (UVC) tips should be in their normal
positions. The tips of the ECMO arterial and venous catheters are
often non-opaque, and their exact positions are often difficult to
ascertain.
In arterial-venous (AV) ECMO the tip of the arterial catheter should be within the aortic arch and the tip of the venous catheter should be within the right atrium.
In venous-venous (V-V) ECMO the tip of the sole venous catheter should be within the right atrium pointing towards the tricuspid valve.
Body wall edema is present because the patient is paralyzed while on the ECMO circuit.
The lungs are opaque due to a combination of fluid in the alveoli, atelectasis, and effusion.
DDX:
Not applicable
References:
See References Chapter.
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